Drugs that cause neuroleptic malignant syndrome

Recent administration of a dopamine antagonist drug or withdrawal from a dopaminergic drug is required for the diagnosis of neuroleptic malignant syndrome.

Dopamine antagonist drugs include all antipsychotic drugs:

• first-generation antipsychotic drugs—chlorpromazine, droperidol, flupentixol, haloperidol, periciazine, zuclopenthixol
• second-generation antipsychotic drugs—amisulpride, aripiprazole, asenapine, brexpiprazole, clozapine, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone.

Although almost all antipsychotics have been associated with neuroleptic malignant syndrome, it is more common with high-potency drugs (eg haloperidol) and depot preparations.

Dopaminergic drugs, which on withdrawal can cause neuroleptic malignant syndrome, include:

• levodopa plus benserazide
• levodopa plus carbidopa
• bromocriptine.